1306896311 NPI number — RHODE ISLAND REHABILITATION INSTITUTE P.C,

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306896311 NPI number — RHODE ISLAND REHABILITATION INSTITUTE P.C,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RHODE ISLAND REHABILITATION INSTITUTE P.C,
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RI REHAB
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306896311
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
721 RESERVOIR AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRANSTON
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02910-4430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-946-4250
Provider Business Mailing Address Fax Number:
401-942-3960

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
721 RESERVOIR AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRANSTON
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02910-4430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-946-4250
Provider Business Practice Location Address Fax Number:
401-942-3960
Provider Enumeration Date:
05/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SISUN
Authorized Official First Name:
HENRY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
401-946-4250

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1235110073 . This is a "OWNER /OP NATIONAL PIN #" identifier . This identifiers is of the category "OTHER".
  • Identifier: HPAA46233 . This is a "HARVARD PILGRIM HC GROUP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: CA-6711 . This is a "RAILROAD MEDICARE GROUP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 7536-1 . This is a "BCBSRI GROUP #" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 19016 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 484225 . This is a "AETNA" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 64-00132 . This is a "UHC" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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